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813-780 -0020 City of Zephyrhills Fire. 1 Fax- 813- 780-0021 <br /> Permit Application , <br /> Date Received X77(9 1 Phone Contact for Permit jr( (I 37 1 <br /> Owner's Name f ,kf C- • s ,/J Owners Phone Number I 3/,3 ' ' 1 1 3 1 an/ <br /> ner'sAddress 547 W dVlW ) Ii-c) ', 4 P r <br /> Fee Simple Titleholder Name I Titleholder Phone Number I I I <br /> Fee Simple Titleholder Address 1 <br /> Job Address 7 0 & 12(Uy 2Z4' i 6 k5 r Lot # h..:. <br /> Sub Division Parcel # <br /> Bio -Hazard Waste Storage - ANNUAL Fumigation Tent <br /> Ei Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 1utrly) (semi (j Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm 1 ❑ ❑ $, f ( n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ ( ( n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ ( ( ( 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> 1 Flammable Application- ANNUAL 1 1 Valuation of Project <br /> — 1 Fuel Tanks <br /> n Other: <br /> Contractor Company <br /> / <br /> Signature GLZi'�C� Registered 0 N j Fee Current I CD/ N <br /> Address r 54-7( J Ow's - 1 7'41,4e4 License # I 113 ((a3 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current 1 Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Cun-ent I Y/ N I <br /> Address License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current I Y' / N j <br /> Address ( I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I I <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required. (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpi /appraiser.pascogov.com) <br />